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Positive Pressure Caps

Anyone can suggest the best Positive Pressure Caps on the market today? I appreciate responces.

 Inna P.


Additionally, due to the high level of importantce, i.e effective October 2008 CMS will no longer reimburse hospitals for hospital acquired infections, there are a few other ways to ensure the best valve selection. Look to the FDA for guidance, has the valve been tested to the most recent testing guidelines? Many of the valves on the market were designed to eliminate needlesticks rather than infection.  In 2005 the FDA posted new more clinically relevent criteria for new valve approval.  While all valves can and should submit evidence permitting them to make the same claims most have not done so. (why?) An easy way to establish wether or not the valve has met the most recent guidelines is to simply look at the date, was it issuewed before or after 2005? 

Another important question: Does the valve technology support and promote best nursing practices?  Many invitro tests tell us information that is not "bedside relevent" because it does not reflect the real bedside usage. (repeat insertion with the same luer, lack of disinfection of the valve) 

Remember the purpose of the valve is to protect the line hense protect the patient. It is easy to isolate features.  But bedside outcomes are showing that it is a  combination of features (ability to disinfect, visible fluid path, consistent line clearence) as well as good practice. Like our industry experts have said, most importantly we must keep the All bacteria out, many devices to not allow nurses to do that no matter how much they try. 

I surveyed some youger nurses at a teaching institution using a negative reflus device that is used on central lines. None of them had ever been taught the positive flush technique needed to maintain these lines. All of them describe occlusion issues even visual "tails" when they remove lines. 

Hope this helps in you descision. 




rivka livni
It is a tricky question, I

It is a tricky question, I do not hink I can endorse one cap over another, there is no consumer report on such a thing.

When I had to choose one for my hospital, I got 3 different companies to show me their caps plus give me reference of "satified cutomers" I then called all the customers, talked to the IV teams, I examined the different caps myself, try to see which are easy to use, what would be the pitfalls, then made a decision which one to use, and am very happy with the results.

Let me just say, it will take staff eduction, and you must be ready to do the hard work.

Needleless connectors - a

Needleless connectors - a complex issue.  Search this forum and you'll find tons of information, including references to M. Ryder study from Center for Biofilm Engineering.  They looked at the amount of bacterial transfer through at least 11 different connectors, and the results were compelling.

You must know what type of connector you're looking at - not just that it is positive, negative, or neutral displacement.  Is it split septum or mechanical valve?  What is the topography of the cap like - smooth?  irregular?  What is the priming volume?  Is the inner lumen smooth?  Are there moving parts? and more.....

All of these relate to occlusion and infection risk.

Also understand that most nurses (especially baby boomers) have been flushing catheters with the positive pressure technique (used in negative displacement connectors), and speaking as an educator - it's amazingly challenging for them to change their "body memory" - behavior.  If you start using a positive displacement connector, be prepared to provide excellent education, with consistent reinforcement.  You'll probably want to do before/after audits and QA studies as well.






Mari Cordes, BS RN

Nurse Educator IV Therapy
Fletcher Allen Health Care

Mari Cordes, BS RNIII VA-BC
Vascular Access Department
University of Vermont Medical Center

What maybe works for me is

What maybe works for me is maybe not the best choice for you. I only can refer to my experience.

At first there is not such a thing like a neutral cap!! I know, strong words but we have negative caps, less negative caps and positive caps. ( and some don't have FDA approval)

Anyway, the best outcome for me and the best cap I think is the MaxPlus from Medegen.

Andre Schotte

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